Julie's Back Home !!

[Josephine]

Osteochondritis dessicans, chondritis and avascular necrosis are essentially the same condition but arising from different sources and in slightly different places - usually. OD usually occurs in adolescents and young adults still in growth. AVN is usually from previous damage or chemical intake such as steroids. Chondritis is usually an inflammatory process or the cartilage.

But they all have similar affects being damage arises in the cartilage sometimes the full thickness of it to the bone and including the bone when tiny, medium and sometimes large pieces of bone separate out and can end up causing arthritic changes.

Like arthritis, these conditions don't actually travel to other sites or joints but can affect more than one joint though, unlike osteoarthritis, it is uncommon for it to do that.

Most common joints affected by OD are the knee, the navicular bone in the foot and the femoral head when it is known as Perthes disease. It is an idiopathic condition meaning the cause is unknown.

In Chondritis, it is the knee and some of the carpal bones in the hand. Another idiopathic conditon.

AVN mostly in femoral head and the knee. Usually caused by micro trauma and/or prolonged use of medications such as steroids.

 

[Juliep]

Jo, this is the first time I've seen something so well written about these conditions. Thanks so much for making it easy to understand.

I will see the full written report tomorrow from the knee. I know it has to do with the outside lateral portion. I then see my OS on Thursday for my 8 week hip follow up and he'll then review the images of the knee. What I've read up so far on the OCD which in essence was what radiologist suggested in his brief reading shows that really sugery once again would be only option? Of course my left hip is starting to hurt as well. I will ask for him to put me on a limited work schedule as well.

I have been told that this was an unknown "idiopathic" reason and they don't have an answer for me. Do they do pathology on the old hip when they remove to see what may have caused the disease?

Thanks again for such helpful information as always. I feel like I'm just breaking down.

 

[Josephine]

I know the feeling Julie! Getting old really sucks, doesn't it!

Lab tests won't reveal a reason because years of case studies have shown that to be the case. So there's no point in further tests since they already know what the problem is and according to the texbooks it is an idiopathic condition.

Surgery on the knee depends upon the degree of damage. There is a grading scale of the disease

You can see more about treatment options here Osteochondritis dessicans. If there are any terms in there that you need explaining, please feel free to copy/paste them in here and I will explain them for you. For instance:
~ "high signal" indicates separation
~ physis and epiphyseal plate are the lines where growth occurs in young bones. These generally disappear in the late teens/early twenties, coinciding with the popularly defined point of maturity of 21 years!

 

[Juliep]

WOW once again Jo, thanks !!!! You are a wealth of information. I'll see the full written report today so should possibly know the stage then and if not I know my OS will know the stage when I see him on Thursday.

I so do appreciate your help with explaining this.

Have a great day!!! Another work day for me again until I see the doc and he can hopefully put me on a reduce work schedule (since I can really do my work from home anyway).

Wish me luck.

 

[Josephine]

Good luck and glad I could help. It just so happens it was one subject I took an interest in way back when!
Not a lot I don't know about the incidence and treatment of OCD!

 

[Juliep]

Well since you know a lot about it, here goes MRi results:

IMPRESSION: Abnormal lateral femoral condyle with two foci of abnormal signal the largest portion in non-weight bearing portion of the femoral condyle, concerning the focal area of osteochondritis dissecans, second possibility would be spontaneous osteonecrosis. Smaller signal alteration anterior aspect of the lateral femoral condyle interrupts the coritcal surface and is certainly of concern for OCD as well.

2. Incidental notification of a probable enchondroma involving the distal femoral shaft.

So, Jo, your opinion?? He goes into a lot more under findings and things being significant.

My GP says he thinks I need to see Rheumatologist for complete blood work up as I did this about 4 years ago when I had sudden total onset of joint pain and all panels were done and showed negative, but my GP thinks it would be good to do this again (ie: Lupus, etc.)

I see my OS Thursday so I guess I'll know where/what gets done to the knee. Hey, I may be writing a post in the knee forum next.

 

[Josephine]

The position of the two erosions in the non-weight bearing areas of the condyle are not unusual. Sometimes the erosions are just soft patches which may respond to needling or drilling (causing blood to come to the area and stimulate bone and cartilage growth) but they can be from that all the way up to a chunk of cartilage with bone attached separating away and becoming a loose body in the joint. Sometimes so large they can be pinned back in place to fill the cavity left. But the damage can cause pain and in later life, be the prelude to osteoarthritis.

The enchondroma involving the distal femoral shaft is a cyst from cartilage tissue which develops inside the bone, in this case the end of the femur at the knee. They may or may not be a problem but if they are, the cyst can be cleaned out and packed with bone graft to heal the gap.

 

[Juliep]

O.K., now for one more line in the report. I don't know how I can attach something like a report. The print is pretty small anyway. Guess they didn't want it to be read.

There is significant posterior subchondral bone marrow signal alteration also involving the posterior subcortical lateral femoral condyle and smaller anterior subchondral bone marrow signal alteration aslo involving the lateral feoral condyle. This latter anteior lesion is relatively intermediate signal on T1 and bright signal on T2 and abuts and interupts the anterior cortical surface.

Wow, that was a lot of jibberish. LOL.

I guess I'm anxious to know what I'm looking at??? Surgery?

 

[Josephine]

They do love to use a dozen words where one would do, don't they!

Basically all he's saying is there are two places on the lateral femoral condyle (the outer side of your knee), one is towards to back (posterior) and the other is more to the front (anterior). The anterior one is mostly in the cartilage but does involve the surface of the bone somewhat and the posterior one, which is marginally bigger, is more in the bone than the cartilage.

I would surmise from this that the anterior lesion has damage which could affect the joint in terms of pain whilst the posterior one, being deeper, wouldn't affect the joint surface so much and therefore might be less likely to cause pain.

 

[Juliep]

8 week follow-up & now knee issue!!

Well I went today for my few days past 8 weeks follow-up. Hip is doing well, except he still is not happy with my strength in the Quads. I did have MRI of right knee after my slip & fall at 4 weeks post op and it showed Osteochondritis dissecans??? Huh? Well it kind of goes hand in hand with Necrosis and Jo has pointed out to me as well. Thanks again Jo for all the good info you have provided. My OS didn't seem over concerned yet. He went ahead today and gave me an injection into the knee and said no exercises for hip until Monday and then buy a 5lb weight to put around ankle and has a couple exercises he wants me to do twice a day.

My GP did blood work up for me as well and of course bit anemic and then referred me to Rheumotologist who I saw yesterday. He ordered bunch of blood work to again check for anything that could cause the AVN so off I went to lab after OS and after knee injection and they took 11 vials of blood.......UGH when I'm already slightly anemic and of course good old mother nature came to see me yesterday too !! Needless to say, I decided not to go to work and come back home and rest.

My OS sees no need for any further pain meds, only OTC like Tylenol and back to see him in a month to see how strength in Quads are getting and how knee is doing.

Sure am hoping to get a late summer vacation in here somewhere.

Oh I did finally ask today what the implant was? Never had asked. He told me it's a BiometTaperloc Microplasty Stem and Mallory-head radical or something like that as I was jotting it all down. Jo: I'm sure you know what the latter part is since I really couldn't find that in my google but I found the Taperloc.

 

[Josephine]

Julie, I added your post onto your previous thread as you have referred to information I gave you about OCD. Some people might find it more helpful.

The prosthesis: Taperloc will do. Sound implant.

As for the blood - well they really only take a few mls of blood so it's not going to impact on your anaemia! Neither is 'Mother Nature'!

The Tylenol: make sure you take two extra strength Tylenol and not just one regular. :wink1:

 

[Juliep]

Thanks !! I've been doing 2 - 500mg when I take them after lunch time usually.

Glad to hear it's a "sound" implant.

 

[Juliep]

Well it's been since Thursday when the injection was done for me knee and I still don't feel anything different. Jo - it hurts on the right side of the knee along the whole side with weight bearing. My OS said that the OCD was mainly in the non-weight bearing area and bascially dropped the subject, did the injection and said I need to start today with the 5lb weight on ankle and doing the exercises to get Quads strengthened and then the knee won't hurt???

This is getting really old because it's hindering my hip recovery (walking without limp)

Any ideas?

 

[Josephine]

Right side of which knee? It makes a big difference!

 

[Juliep]

Oops, how about outer side of right knee.

 

[Jaycey]

Hi Julie - 5lbs sounds like a lot to start with. Can't you start with less weight and work up? Just my opinion.

 

[Juliep]

Jaycey you are darn right!!!! The store yesterday didn't have the 5lb so I bought two 2 1/2 lb straps and I tried putting both on and doing it, right.... Now when I put the 2 1/2 lb strap on I was able to lay and do the leg raise about 6 inches off the ground (bed) and hold for 5 seconds and did 10 of them. He wants me to do 3 sets of 10 with 5 lbs. I don't know what he's expecting out of me especially with this OCD now in my knee and my knee hurts??? The injection doesn't seem to have done anything. I just saw from my insurance claim that it was a Triamcinolone injection (steroid) which kind of puzzles me since I have necrosis why inject more of a steroid? I guess I'm just confused by this all.

I wasn't even told if I should wear a knee support, but I'm doing it anyway to give some support for when I walk.

 

[Jaycey]

5lbs just sounded like overkill since you are just starting this!

As with any PT don't do things that cause pain. Start with the smaller weight and a few reps. Then when you can do 3 sets of 10 with that one, move up just a bit more. As we say - no pain means lots of gain.

 

[Josephine]

That's better! And that tells me it's the ITB band. Look here Ilio-tibial band (ITB) issues and pain: exercises

Now about those weighted lifts - with ITB syndrome, the last thing you need to be doing is straight leg raises at all never mind with weights! You need to get that issue sorted first.

As for the steroid injection, that kind is a small dose specially for intra-articular use and not to be confused with the general treatment type which is stronger and does cause joint problems. The I/A stuff can be safely given at intervals not less than 3 months apart without being a hazard to the joint.

 

[Juliep]

Jo, the description in the link you gave me is exactly where and how it feels with getting out of car and stairs, etc.

Glad to know about the steroid injection as well.

Big thanks again !!!